HEMORRHAGIC TRANSFORMATION IN ACUTE ISCHEMIC STROKE - POTENTIAL CONTRIBUTING FACTORS IN THE EUROPEAN COOPERATIVE ACUTE STROKE STUDY

Background and Purpose Recent studies suggest that thrombolytic therap y may be of benefit to patients with acute ischemic stroke. However, t he treatment also carries a significant risk of hemorrhagic transforma tion (HT). The purpose of this study was to select potential contribut ors to HT. Methods We provide an explanatory analysis of the European Cooperative Acute Stroke Study (ECASS) data. ECASS was a multicenter, placebo-controlled, randomized trial of recombinant tissue plasminogen activator in ischemic stroke, within 6 hours of symptom onset, which enrolled 620 patients. HTs were classified into either hemorrhagic inf arction or parenchymal hemorrhage according to their CT scan appearanc e. We used logistic regression analysis to select potential contributi ng factors to each type of HT. Results The severity of initial clinica l deficit (odds ratio [OR], 2.5; 95% confidence interval [CI], 1.6 to 4.0) and the presenceof early ischemic changes on CT scan (OR, 3:5; 95 % CI. 2.3 to 5.3) were associated with increased risk of hemorrhagic i nfarction. Increasing age (in decades; OR, 1.3; 95% CI, 1.0 to 1.7) an d treatment with recombinant tissue plasminogen activator (OR, 3.6; 95 % CI, 2.1 to 6.1) were related to the risk of parenchymal hemorrhage. Conclusions Since all potential contributing factors are readily disce rnible upon hospital admission, they should be used to improve selecti on of patients into future studies.